Research Review

New Study Finds 'Suicides by Drugs' Profoundly Undercounted in the United States

According to the Centers for Disease Control and Prevention, the suicide rate in the United States increased by 34% between 2000 and 2016. While that rate seems high, a team of researchers led by a West Virginia University (WVU) faculty member believes it is seriously underestimated.

A new study suggests that the difference may be due to drug intoxication suicides being misclassified. Ian Rockett, a professor of epidemiology in WVU's School of Public Health, spearheaded the study conducted by an international team of renowned epidemiologists, psychiatrists, emergency physicians, and a chief medical examiner.

"There is a serious problem of suicide undercounting in the United States, which stems from the opioid epidemic and under-resourcing of emergency health care and death investigation systems," Rockett says. "Our analysis of data from the CDC's National Violent Death Reporting System shows detection of drug intoxication suicides is highly dependent upon authenticated suicide notes and psychiatric histories. This information is often minimal or nonexistent, which impedes both suicide understanding and prevention."

The researchers claim that suicide notes and psychiatric history, including a prior suicide attempt or diagnosed depression, are much more important in properly identifying drug suicides than suicides completed by more violent and obvious methods, like shooting or hanging. However, the study revealed that such evidence is absent in two-thirds of known suicide cases and in three-quarters of undetermined death cases, a comparison group. This lack of evidence often leads to suicides being classified as undetermined or even accidental and ultimately inhibits the detection of drug suicides.

The nation's growing opioid epidemic, coupled with the under-resourcing of emergency health care and death investigation systems, is exacerbating problems with suicide accounting, the researchers report.

"Without this evidence, we are significantly underestimating suicide as a clinical and public health problem," Rockett says. "We need to more accurately identify all types of self-injury behaviors to ensure we are providing appropriate treatment, education, and prevention programs."